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My wife recently had a significant surgery. It was handled expeditiously, outsourced to a top-notch surgeon in Nashville. No issues, but Tricare capped the payment to the doctors at approximately $9k. It was billed at $38k, so there must be a pretty significant markup.

'Glad that this worked out ok but you are only seeing this from one side. It’s not that there is a significant mark up as such, it’s that insurance companies demand large discounts, which has created inflated charges. (Tricare is effectively acting as a government medical insurance company).

Not so long ago, if you were sick or injured, you went to a medical provider (doctor, hospital, etc.) where you were treated. There was some flexibility but mostly there was a charge for whatever you had done and you paid it.

Then someone figured that they could take the uncertainty out of your personal medical costs and make a profit, by providing a service – you paid them a regular amount and they paid for your medical treatment. Medical insurance was born and it created some upward pressure on medical costs because they were no longer as constrained by how much you could afford to pay. But this was minor compared with what happened next.

As employers started to contribute to medical insurance and more and more people were covered, the insurance companies, with an eye on their profits, created networks of approved medical providers and negotiated discounts for services with those providers. As the insurance companies got bigger, it reached the point where doctors and hospitals couldn’t survive if they weren’t part of the network, so the insurance companies negotiating power became greater and greater and they demanded bigger and bigger discounts. But the medical providers still had to make a living, so they started increasing their fees to compensate. This created an upward pressure on “published” prices across the medical community.

We are now at the stage where published charges are much greater than are actually being paid - as long your medical costs are being paid my an insurance company, that is. The problem is that some poor smuck who is uninsured or not covered by their particular insurance, ends up paying a very inflated price. Sometimes a doctor will try to help those who pay out of pocket and who don’t have much money by “cheating” on the billing but it is a big risk for them.

And this is only one of the problems. But of course, we don’t need healthcare reform.

my two cents... and this will have nothing to do with which country has better care, is more affordable, provides faster care, or who has lower taxes. This isn't in response to anything anyone has said in particular, but a general response to comments about greed and/or money.

Care is based on the individual care provider, and there are good and bad people everywhere you go (in every way). There are good doctors everywhere you go, just more of them in some places...

On the point of the cost of healthcare, no matter where you go: don't be upset that your surgeon or physician wants to make good money. Doctors have worked incredibly hard to obtain their education and training, and sometimes the things they do are just plain amazing.

Frankly, if a pediatric heart surgeon who can repair the still-beating heart of a premature neonate by hand and see that child become well enough to leave the hospital and live a healthy life, then if he or she wants to drive a Porsche or Ferrari and live in a huge house then I have absolutely no problem with that what-so-ever. Now let me contrast that with the money an NBA basketball star is making and I'll ask you which one is contributing more to humanity? People are willing to spend thousands (and thousands and thousands) of dollars on season tickets to professional sports while wearing their team sweatshirt they paid $100 for because it's got a licensed logo don't seem to have an issue with it. But then if they have to pay a co-pay for a surgery they're upset. Again, this is not in direct response to anyone or any post. Just an observation of where we spend our money and how I feel it's misdirected at times.

Another thing to consider is that health care in the US is often expensive to make up for those that aren't paying for it. You go the emergency department here and you cannot be turned down based on your ability (or inability) to pay due to Federal law. Many of those bills go unpaid and the cost is recouped in other revenue streams. Nope, it doesn't actually cost a few grand to get an x-ray, but the last three people might not have been able to pay for theirs. Fair? nope... not saying it is, just saying it's a reality. Also, bear in mind hospitals have non-revenue departments that need to be paid for... like security, IT, grounds/maintenance.... They don't make money for the hospital, but that's going to have to be paid for too, thus procedures and care start looking expensive.

Anyway.... just wanted to interject a few of these thoughts. How any country pays for healthcare is not a simple equation. It's complicated stuff and is different from one region to another. I personally don't have any experience as a patient outside the US, but have taught emergency medicine in South America and feel confident that we take a lot of things for granted in North America, whichever country you're in.

biology,

You are so right!

And the bolded part is why I do not and will not support professional sports of any kind. (I also hate t-ball through high school stuff too).

11-07-2012 03:36 PM

biology

Re: Our Medical Experiences in Mexico

my two cents... and this will have nothing to do with which country has better care, is more affordable, provides faster care, or who has lower taxes. This isn't in response to anything anyone has said in particular, but a general response to comments about greed and/or money.

Care is based on the individual care provider, and there are good and bad people everywhere you go (in every way). There are good doctors everywhere you go, just more of them in some places...

On the point of the cost of healthcare, no matter where you go: don't be upset that your surgeon or physician wants to make good money. Doctors have worked incredibly hard to obtain their education and training, and sometimes the things they do are just plain amazing.

Frankly, if a pediatric heart surgeon who can repair the still-beating heart of a premature neonate by hand and see that child become well enough to leave the hospital and live a healthy life, then if he or she wants to drive a Porsche or Ferrari and live in a huge house then I have absolutely no problem with that what-so-ever. Now let me contrast that with the money an NBA basketball star is making and I'll ask you which one is contributing more to humanity? People are willing to spend thousands (and thousands and thousands) of dollars on season tickets to professional sports while wearing their team sweatshirt they paid $100 for because it's got a licensed logo don't seem to have an issue with it. But then if they have to pay a co-pay for a surgery they're upset.

Again, this is not in direct response to anyone or any post. Just an observation of where we spend our money and how I feel it's misdirected at times.

Another thing to consider is that health care in the US is often expensive to make up for those that aren't paying for it. You go the emergency department here and you cannot be turned down based on your ability (or inability) to pay due to Federal law. Many of those bills go unpaid and the cost is recouped in other revenue streams. Nope, it doesn't actually cost a few grand to get an x-ray, but the last three people might not have been able to pay for theirs. Fair? nope... not saying it is, just saying it's a reality. Also, bear in mind hospitals have non-revenue departments that need to be paid for... like security, IT, grounds/maintenance.... They don't make money for the hospital, but that's going to have to be paid for too, thus procedures and care start looking expensive.

Anyway.... just wanted to interject a few of these thoughts. How any country pays for healthcare is not a simple equation. It's complicated stuff and is different from one region to another. I personally don't have any experience as a patient outside the US, but have taught emergency medicine in South America and feel confident that we take a lot of things for granted in North America, whichever country you're in.

......the point is moot since the population of the US is more than 4x that of the other four. More instructive are the numbers to the right (foreign-born popn). Using this measure the US is not close to the highest so this would suggest that other places are highly attractive (Switzerland, Canada and Australia stand out)......

While graphs can be misleading, I think this one is correct.

As the world's population considers where it might emigrate to, its decision is not based upon how many people are already in the destination country. The proper denominator would be the planet's population. More people on the planet chose to go to the US during that decade than any other country. That's what the graph is saying. The US would still be in the same relative attraction, whether it's population doubled or halved.

More people immigrate to the US than nearly the next four countries combined. Overall, on average, we have something more attractive than anywhere else on the planet. Warts and all. Mexico didn't make the top 15. Canada, with their nationalized health care, made a good showing at about a quarter of the US. Seems to take more than nationalized health care.

I know this is an old discussion but I have been off sailing. My comment is not about foreign healthcare, although we have been pleased on the few times we have needed it in places like French Polynesia and Fiji. Rather it is about chart reading and the conclusions that one can and should draw. This looks like a chart from The Economist (great publication by the way, not sure why they call it a newspaper though). There are two sets of stats in the graphic. You use the bars graphs to suggest that the US is the most attractive destination for immigrants by saying that there are more in the US than in the next four countries combined. This is true, but the point is moot since the population of the US is more than 4x that of the other four. More instructive are the numbers to the right (foreign-born popn). Using this measure the US is not close to the highest so this would suggest that other places are highly attractive (Switzerland, Canada and Australia stand out). Don't know if this data includes illegal immigrants or not, but I suspect it does.

10-28-2012 02:29 PM

tankersteve

Re: Our Medical Experiences in Mexico

I am in the military so I am the recipient of socialized medical care here in the United States. My wife recently had a significant surgery. It was handled expeditiously, outsourced to a top-notch surgeon in Nashville. No issues, but Tricare capped the payment to the doctors at approximately $9k. It was billed at $38k, so there must be a pretty significant markup.

We also lived in Canada for a year, as part of an exchange program. My younger daughter was born in Toronto. The experience was excellent. Our first doctor was an ass - we immediately requested a new ob/gyn and got one who was much more in tune with my wife's needs/desires (second birth).

Our first child was born in Germany. Not a great experience, but the quality of the care was very good. Still, setting the mood with candles in the delivery room was unique. We also visited a pediatric emergency room in Sicily once, and left after great care and didn't owe a cent.

We intend to head out in a few years when I retire, and are actively following threads like this, discussing the kind of care available in other countries in the Caribbean and Central America and Mexico. We have high expectations about the potential care we will receive.

While living in Korea several years ago, my wife saw a doctor on the economy on very short notice and received excellent care.

Americans need to get over the idea that we are always the best and everything is done the best way possible here. Our experience is that medical care isn't too shabby in lots of other countries, and while sometimes you need to manage expectations, often the care is just as good as, if not better than, the US.

......I suspect YMMV depending on where you live, but I'm sure that is the case in United States.......

Not really. If more expedient or appropriate medical care is too far away in the US, and you don't have the means to get to it, we have an infrastructure to fly you there for free on private aircraft. I know, because I volunteer to fly for them.

..............
He was not surprised, but gave me a good explanation as to why they'd always told me it was something that couldn't be fixed, as the billing they could send the government for dealing with it wouldn't cover their cost for it, and that it was a common problem with Canadian medical care. He fixed it in under a minute, with a single small syringe. The only doctor back here I could bother into dealing with it took a half hour, poked my wrist full of holes, broke a syringe and generally made a mess.

He figured out a few other health issues I've had for years, and suggested that I see if I could pester a doctor here into sending me to a specialist, but I've had no luck so far.

It is unconscionable that a doctor would not treat you.

I just had a friend give me the bad news he was diagnosed with a tumor in his bowels on Thursday. He will be in surgery on Tuesday to get it removed. I cannot think of a possible faster situation any where.

It just reaffirms to me, at least in Alberta, that if you need health care, it's there. I suspect YMMV depending on where you live, but I'm sure that is the case in United States, and I know it is in Germany and Ireland, where I have cousins who are doctors.svs

I am Canadian, and needed to use the system a few years ago for a serious illness. Guess what? My choice of doctor, my choice of specialist and my needs met NOW. No delays, no 'panels' and no bureaucrats.

I called my doctor for to get an annual done last month, I was in 3 days later, he wanted a specialist to check out one thing, I saw that specialist 4 days later, and all was fine.

Yup, but he could have gone to a private MRI and got it done the same day, at worst the next. He chose the government pay route. His obviously was not a life threatening issue. I had my MRI and catscans done as needed. No waiting. No charge.

Your friend had the option of going to a private MRI clinic. Your point is?

Keep in mind, Canada sends 1/3 less as a percentage of GDP on healthcare as opposed to the USA and guess what? We get better results... we live longer.

Our taxes are less... even Romney commented on that in the debate last night. Our debt as a percentage of GDP is far less than yours, and our deficit should be gone in 3 years. We have a trade surplus, and considerably less unemployment than the USA. Our banking system is recognized as the best in the G8.

I would not trade you my health care system for yours ever. My friends in the States, who have healthcare coverage, can only go to doctors their HMO allows, need pre-approval on procedures, have to consider their co-pays in the timing of appointments, and need to make decisions based on financial considerations, and not health ones. And they work for a government agency, not a private concern.

I don't lose coverage due to preexisting conditions, and I don't have to worry about changing jobs and worrying about what will change in my coverage.

Nope, won't trade ours for yours, ever. We pay less to get healthcare and we live longer. The proof is in the pudding.

Sounds more to me like you got lucky... Are you in BC? My experience and the experience of most of my friends is very different. I've been on waiting lists and trying to get a doctor for a couple years now. My choices are the walk in clinics(where you are under pressure to hurry up and leave and have <10 minutes to meet, explain try and convince them to think about checking something, or the ER(where you wait even more hours than the walk in, last time was several hours while I was coughing up blood, and almost unable to breathe, to be given a chest x-ray and told to piss off as it "probably wasn't TB or cancer"). Wwhether the cause is immediately life threatening or not, I'd prefer not to feel like I'm drowning if I lie down, this has happened at least once a year for the last several.

Even relatively minor stuff, which I know could be inexpensively dealt with and which would make a big difference to pain at work for me won't be done(cost about 10$ for a syringe every few months, or a very short day surgery).
The reason nobody would deal with it, and the first time I even found out it could be dealt with was when I was dating a doctor's daughter.
He was not surprised, but gave me a good explanation as to why they'd always told me it was something that couldn't be fixed, as the billing they could send the government for dealing with it wouldn't cover their cost for it, and that it was a common problem with Canadian medical care. He fixed it in under a minute, with a single small syringe. The only doctor back here I could bother into dealing with it took a half hour, poked my wrist full of holes, broke a syringe and generally made a mess.

He figured out a few other health issues I've had for years, and suggested that I see if I could pester a doctor here into sending me to a specialist, but I've had no luck so far.

10-18-2012 07:40 AM

Minnewaska

Re: Our Medical Experiences in Mexico

cupper. Who is asking you to trade? Why do private MRI facilities even exist up there?

The US healthcare system is broken and we didn't come close to fixing it with Obamacare. That was predominantly a social program, not a fix. However, when we do, the Canadian system won't have the same availability it has today. Like all business, your most profitable customers are typically carrying the load for the rest. Business considers the smaller players to be incremental profit at lower margins, that's how Canada gets away with negotiating capped pharma costs with the suppliers. However, once you start making less on your most profitable, that gets passed to the rest. If I were in your shoes, I would want the US to keep things just the way there are, but we won't.

Mexico is going to have the same problem. However, Mexico also has a serious pharma counterfeiting problem. One out of every 10, in fact. Counterfeiting exists everywhere, but can you imagine going to a pharmacy in the US and thinking there is a 1 in 10 chance that your bottle is fake? That's scary.